“Until we start to view mental illness as an illness that impacts your brain the same way we view an illness that affects your heart or your kidneys, we’ll continue to face the devastating consequences caused by stigma,” Eldredge -Senior Director of Clinical Operations at Huntsman mental health institute, Utah.

I remember receiving a book many years ago entitled Depression is a Choice. It infuriated me that someone had the audacity to suggest that the depression which would often visit me was somehow optional in nature. Drawing from her own experience the author argued that you could control depression without drugs and “endless therapy” but for myself having gained from both therapy and medication (and still do), her reference to depression as a choice was a hard pill to swallow. I did recognise parts of her writing which advocates that people take responsibility for their symptoms of depression through steps they can take to shift thinking patterns etc. but mostly the idea that depression was optional added fuel to the fire of the “pull yourself together” and “look on the bright side” brigade and didn’t help lessen societal stigma. 

Stigma was and still is quite common and incredibly dangerous. When we treat mental health and substance-use disorders as choices that can be controlled rather than as medical conditions that can be managed and treated, we isolate those suffering and create an atmosphere of blame and shame. The ambient feeling of guilt around mental health issues can cause those experiencing them to avoid seeking professional help or even seeking comfort and understanding from their peers and loved ones. Embarrassment or guilt around depression or any other mental health condition is as outdated as thinking you are weak or flawed for needing to wear glasses.

Stigma around taking drugs (happy pills) and therapy (seeing a quack) remain two of the biggest barriers to getting people to seek help with their mental health challenges even though serious forms of depression are best treated through pharmaceutical and psychoanalytical interventions. As one reviewer of the book said, “Finding medication that stopped my bipolar mood swings was the best thing that ever happened to me in my entire life. No amount of Cognitive Behavioural Therapy could “fix” me, until I was in enough control of my moods to think, with a coherent understanding that didn’t reverse direction every week.”  

Without doubt a quarter of a century later people’s awareness and understanding about the importance of mental health and psychosocial well-being has increased significantly, especially since the pandemic. We have also seen increased calls to action on mental health from world leaders and several UN organisations in the last couple of years. However, more awareness, advocacy, guidelines and plans around mental health are not enough, if not followed by investment in and implementation of evidence-based and scaleable mental health interventions promoting a rights-based approach across countries. Increased integration of mental health in public health services, accessible digital mental health platforms and programmes, alongside community-based approaches and interventions can play a key role here. Bringing mental health awareness, training and support in the workplace also plays a significant role.

Recently during an interview for BTV I was asked where mental health awareness and education should start. School is the obvious place and should have priority status. When I went to school, I didn’t even know what poor mental health was even though I intimately knew its feeling. I figured it was normal to wake up every morning feeling unhappy, and so became resigned to it. I did not know that therapy existed let alone that pharmaceutical options were available to help. Even though that was forty years ago I suspect many students in Botswana today wake up the same way and with the same ignorance. Workplaces and local communities too are also other places where mental health can be placed at the forefront of the agenda. No individual, school, workplace, society, or nation can act successfully alone. We need to unite and collaborate effectively across nations, sectors and disciplines towards mental health goals and commitments. 

Singer, songwriter, and mental health advocate Jewel Kilcher recently said, “In the not-so-distant future, every family, organization, college, and corporation should have a Chief Mental Health Officer, or a strategic plan for the mental health of those in their care. This is how we can not only invest in people as students and employees, but as humans with brains and feelings. And it’s how we can make good on the traditional investment we, as a society, have made in identifying and cultivating rare talents by not only helping them have the resources they need in school or work to excel, but, more importantly, the resources they need to be happy.” 

Today I know that depression isn’t a choice, but stigma and ignorance is!